Cognitive Behavioral Stress Management for Chronic Fatigue Syndrome

描述(申请人提供)：这是一项为期4年的研究，使用为期10周的基于电话的认知行为压力管理干预(T-CBSM)，相对于接受健康促进电话(T-HP)干预的参与者，阐明压力和压力管理对慢性疲劳综合征(CFS)患者身体健康状况和免疫调节的潜在神经免疫机制。CFS的特点是身体症状，导致生活方式、行为和职业活动受到严重限制。相关症状包括虚弱乏力、低烧、淋巴结疼痛和压痛、认知障碍和情绪变化。越来越多的证据表明，CFS患者也可能在HPA轴功能和免疫功能的几个指标上表现出异常。慢性应激也与皮质醇的昼夜分泌模式平缓有关。无法维持HPA轴的调节可能通过减少对促炎细胞因子的控制以及与慢性免疫激活和炎症相关的身体症状而导致CFS的病理生理学。鉴于CFS的衰弱性质，我们建议通过电信系统(即Telecare)提供T-CBSM干预，旨在为可能难以进入传统心理治疗环境的人群提供更多获得正式和非正式护理的机会。在我们之前对CFS患者的工作中，我们已经表明，与对照条件下的个人相比，结构化小组CBSM干预的个人报告显著改善了生活质量、感知到的压力、疲劳、记忆、肌肉疼痛和劳后不适。Telecare系统成功地为痴呆症患者的老年照顾者提供了支持性干预。这项研究在将我们先前的工作扩展到CFS患者方面具有新颖性，这些患者报告由于身体负担而难以参与结构化小组。研究设计为2×3随机设计，组间因素为T-CBSM组(n=60)，组内因素为时间(干预前、干预后和6个月随访)。我们的主要目标是评估T-CBSM干预在多大程度上可以通过调节神经免疫相互作用来改善CFS的身体健康状况和免疫调节，该干预旨在建立降低焦虑、耐受痛苦、评估应激源和适应性应对策略方面的技能。

DESCRIPTION (provided by applicant): This is a 4-year study that uses a 10-week telephone based cognitive behavioral stress management intervention (T-CBSM) to illuminate neuroimmune mechanisms underlying the effects of stress and stress management on physical health status and immune regulation in individuals with chronic fatigue syndrome (CFS) relative to participants receiving a health promotion telephone (T-HP) intervention. CFS is characterized by physical symptoms which bring about severe limitations in lifestyle behaviors and vocational activities. Associated symptoms include debilitating fatigue, low grade fever, lymph node pain and tenderness, cognitive difficulties, and mood changes. There is growing evidence that CFS patients may also show abnormalities in HPA axis functioning and on several indices of immune functioning. Chronic stress is also associated with a flattened diurnal secretion pattern for cortisol. An inability to maintain regulation in the HPA axis may contribute to the pathophysiology of CFS via diminished control of pro-inflammatory cytokines and associated physical symptoms related to chronic immune activation and inflammation. Given the debilitating nature of CFS, we propose to deliver the T-CBSM intervention through a telecommunications system (i.e. Telecare) designed to enhance access to formal and informal care for a population that may have difficulty accessing traditional psychotherapeutic settings. In our prior work with individuals with CFS, we have shown that individuals in a structured group CBSM intervention report significantly improved quality of life, perceived stress, fatigue, memory, muscle pain, and post-exertional malaise compared to individuals in the control condition. The Telecare system has been successful in delivering a supportive intervention for older caregivers of dementia patients. This study is novel in expanding our prior work to individuals with CFS who have reported difficulty participating in structured groups due to physical burden. The study design is a 2 X 3 randomized experimental design with group (T-CBSM, n=60 vs. T-HP, n=60) as the between-group factor, and time (Pre-intervention, Post-intervention and 6 month follow-up) as the within-group factor. Our primary objective is to evaluate the extent to which a T-CBSM intervention Aimed at building skills in anxiety reduction, distress tolerance, stressor appraisals, and adaptive coping strategies may improve physical health status and immune regulation in CFS by modulating neuroimmune interactions.